Healthcare Provider Details

I. General information

NPI: 1386796712
Provider Name (Legal Business Name): ARLENE BUMBACA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E SUNSET RD STE D-34
LAS VEGAS NV
89120-3506
US

IV. Provider business mailing address

2700 E SUNSET RD STE D-34
LAS VEGAS NV
89120-3506
US

V. Phone/Fax

Practice location:
  • Phone: 702-736-2021
  • Fax: 702-795-1084
Mailing address:
  • Phone: 702-736-2021
  • Fax: 702-795-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5011
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: